critical care via peds or anesthesia?

[gclax30]

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Hey folks,

Sorry if this has been discussed in the past but I can't quite find the answers I'm looking for in previous threads...

I am interested in pursuing pediatric CCM. My question concerns the best route for getting there- peds vs. anesthesia residency and then fellowship.

How would the differences in residency training affect how you approach pediatric patients in the ICU? Or rather, how would you approach the same patient coming from these two different training perspectives?

Are there any major differences in skills or knowledge that one field would provide over the other?

If I am interested in going the more academic route in medicine, would my research interests dictate my choice of clinical training?

Thanks for your help!

 

[ZAZA67401]

why not do both...http://www.hopkinsmedicine.org/anesthesiology/Education/fellowship/PICU.cfm#combined_ped

 

[Stitch]

why not do both...http://www.hopkinsmedicine.org/anesthesiology/Education/fellowship/PICU.cfm#combined_ped

Definitely a great route if you're interested in both. It will allow you to round and be involved in the ICU as well as go to the OR. I wonder if eventually you'd have to choose between them though...

But ultimately it's up to you and what you like. If you just like being in the OR and giving critical care over brief periods of time and then moving to the next patient, then look at anesthesia. I don't think most anesthesiologists do peds CCM anymore although there are still a few. If you want to round on kids daily and make longer term decisions, then go peds followed by ICU. That will likely take you out of the OR though. Also keep in mind there will be some chronically ill kids and more end of life care in CCM than anesthesia. You can publish and do academics in both.

 

[oldbearprofessor]

If I am interested in going the more academic route in medicine, would my research interests dictate my choice of clinical training?

I agree with Stitch, the pedi-PICU fellowship route is the usual path for pediatric intensivists these days. In terms of research, there is no doubt that anesthesia training might provide more of a background for research into resuscitation and cardiovascular management, whereas pedi-PICU would be more broad-based including things like nutrition. Basic science research would also be more common in the pedi-PICU pathway although not exclusively so as certainly anesthesia has ample opportunities for this as well in certain areas.

Also ask yourself the basic question: Do I want to be a pediatrician? If you go pedi-PICU you will become a pediatrician before you become a PICU doc. If you really do/don't like that idea, it will help you make a decision.

 

[BigRedBeta]

I think in terms of big differences between peds and anesthesia, the one that jumps out to me is simply dealing with the social, family, and developmental aspects of kids. That's a big part of pediatrics training, and something that you'd miss to a great extent going through anesthesia first. You could/would absolutely pick it up later on, as you continue working exclusively with children, but it'd be the initial difference I think you might notice.

Obviously on the other end, doing anesthesia first is going to make all the procedural aspects of fellowship routine (though I've met a fair number of anesthesia residents who are petrified of intubating kids).

 

[michigangirl]

Hey there! Glad the OP posted the hopkins website for the combined program. That's what I'm doing right now but here are your options.

These days its EXTREMELY rare for anyone to work in a picu with only anesthesia training...you pretty much have to be a pediatrician to do the ACGME PICU fellowship- as you probably already know, that is a 3 year residency followed by a 3 year PICU fellowship. If you are going to work at an academic center with a high-acuity PICU that does ECMO, cardiacs, etc, you have to be ABP certified in pediatrics. That's the classical route= 6 years

On the other hand, if you love anesthesia enough to do it all the time and work four-five days a week in the OR, then you can always do the 4 year anesthesia residency followed by a one year pediatric anesthesia fellowship so that you can work at a children's hospital/academic center primarily doing peds cases and very sick kids- in the OR only= 5 years

The other option, which I chose, was to do the combined fellowship-- this almost always involves applying for peds residency, and in the second year of residency doing an anesthesia elective and seeing if its right for you. Then you apply for the combined program by applying for anesthesia residency AND PICU fellowship-- As soon as you're done with peds residency you start anesthesia residency-- the first two years involve mostly adult anesthesia-- remember, you'll be a board certified anesthesiologist at the end of it-- and then the 3rd year you move on to the PICU. When you're not on service in the PICU (averages to 18 weeks/year over 3 years) you do 2-3 days/week in the OR to fulfull your peds anesthesia fellowship requirement. So from medical school to finish its a total of 8 years (!!!). But if you love the PICU but love anesthesia too, It's a great way to cover both of those passions. Most of the attendings who are combined-trained enjoy it because of the variety, in addition to how being anesthesia trained changes their practice in the ICU. This is also a nice route if you do not plan on being a research based physician, because then you have the OR when you're not on service in the PICU. Salary is also a little better this route.= 8 years

Some people have done peds residency and then picu fellowship and in themiddle of picu fellowship have decided to pursue the anesthesia component which is doable, but a little more complicated. Its also hard enough starting a brand new residency after you finish peds residency, let alone go BACK to being a resident once you're already a fellow.

If you hate adult medicine- anesthesia residency will be no fun- just an fyi-- 85% of the cases you do during those two years are adult.

Alright, let me know if I can answer any other questions-- good luck! I love what i'm doing!🙂